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Kobe Bryant Basketball Academy (2015)
Emergency Medical Release & Liability Waiver
Participant’s Name ______________________________________ Birthdate _________
Street Address_________________________________ City __________
Zip_______
Emergency Contact Information
Name __________________________ Tele(___)___________ Cell(___)____________
(relationship)
Name __________________________ Tele(___)___________ Cell(___)____________
(relationship)
Medical Conditions:_______________________________________________________
Allergies:________________________________________________________________
Medications: _____________________________________________________________
(Participant is responsible for adhering to medication schedule, refrigeration is available)
I the undersigned parent/guardian of the above listed minor (if participant is under the age of 18) (i)
acknowledge and fully understand that participant will engage in strenuous athletic and physical activities
that involve risk of serious injury, including permanent disability or death, and severe social and economic
losses which might result not only from participant’s own actions, inactions or negligence, but action,
inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment
used and further, that there may be other unknown risks not reasonably foreseeable at this time, (ii) assume
all the foregoing risk and accept personal responsibility for the damages following such injury, permanent
disability or death, and hereby release, waive covenant to indemnify and not to sue, and forever discharge
any and all claims of damages or causes of action, including but not limited to, death, personal injury or
loss or damage to property, which participant, I, or any of participant’s representatives, heirs, next of kin or
assignees (“representatives”) may have or which may hereinafter accrue to me or Participant’s
Representatives in connection with Participant’s voluntary participation in the Kobe Bryant Basketball
Academy programs, being transported to or from same, or otherwise, and which may be asserted by
Participant, me, or Participant’ Representatives against Kobe Bryant Basketball Academy, its parent,
subsidiary or affiliated companies or entities, it’s members, owners, directors, officers, and employees, or
affiliated organizations, which participation, after careful consideration, I hereby authorize, and which
transportation I hereby authorize. I acknowledge and accept sole responsibility for all of the hazards and
risks associated with or related to participant’s participation in the programs and for any damage or injury
that Participant may cause to others; I expressly assume all risk of injury (including permanent disability
and death) arising out of participant’s participation in the programs, howsoever caused or arising and
whether by negligence or otherwise, and accept personal responsibility for the damages following such
injury, permanent disability or death. I represent and warrant that Kobe Bryant Basketball Academy has
hereby recommended that Participant obtain medical clearance from a physician and all of the appropriate
insurance (health, disability, etc) prior to his/her participation in the programs. I understand the risks
attendant to Participant’s failure to obtain medical clearance. By my signature below, I hereby represent
that participant either has received a physical examination by a physician and has been found physically
capable of participating in the programs or contrary to the recommendation of Kobe Bryant Basketball
Academy, has decided not to obtain such medical clearance. I hereby give my consent to have an athletic
trainer, coach, nurse and/or doctor of medicine or associated personnel provide the participant with medical
assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or
treatment. I also agree to save and hold harmless and indemnify each of these parties from all liability,
loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed
because of or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the
negligence of releasees. I have read the above waiver/release and understand that I have given up
substantial rights by signing this release and sign below voluntarily. I understand that this document may
not be altered in any manner and that any alteration without the express written consent of the Kobe Bryant
Basketball Academy will cause the participant to be removed from the program.
**I Do ___ Do Not___ authorize non-emergency treatment for minor ailments with use of nonprescription medications. (Including, but not limited to ibuprofen and antacids)
Parent/Guardian signature _____________________________________ date_________
APPEARANCE RELEASE
1.
Basic Information
Company:
Hanzo, Inc. (“Company”)
Individual’s Name
and Address:
Date of Birth:
Date:
2.
Release
I understand that as a participant in the Kobe Bryant Basketball Academy ("KBBA") I maybe be filmed
by Company, third parties engaged by Company, clients of Company and/or affiliates or production
companies engaged by or affiliated with Company, Company's clients or another third party. In
consideration of my participation in KBBA, the mutual promises contained herein, and for other good and
valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby
unconditionally and irrevocably grant to Company, and its successors, licensees and assigns, the right to
use my name and likeness, videotape, film and photograph me and record my voice and conversation
including quotes, paraphrases, sounds or recreations thereof, free of any charge, in connection with the
production, distribution, promotion, and exploitation of any project for which Company so desires, and
for advertising, publicizing and promoting any exhibition of any such project, as well as for Company’s
own promotional purposes, in any and all manner and media, whether now existing or hereafter devised,
throughout the universe, in perpetuity. I further agree Company shall be the exclusive owner of all
copyright and other rights in and to the results and proceeds of my participation in any filming, and any
excerpts therefrom, and that Company will have the exclusive right to use, and license or otherwise
authorize others to use, them, including but not limited to my name, voice, likeness and any biographical
facts which may have been provided to Company (or a designated third party), in any manner Company
wishes and in any and all media now known or hereafter discovered or developed, in perpetuity,
throughout the universe. Moreover, my participation in any project may be edited and/or modified in the
Company’s sole and absolute discretion and that I have no right to inspect, edit or approve the Company’s
use thereof.
In addition, I agree not to sue and irrevocably, knowingly, voluntarily and unconditionally release, waive
and forever discharge Company and any of its past, present and future parents, subsidiaries (whether or
not wholly-owned), affiliates, joint venture partners, divisions, agents, representatives, employees,
successors, clients, licensees and assigns, jointly and individually (hereinafter collectively referred to as
“Releasees”), from any and all manner of liabilities, claims and demands of any kind or nature,
whatsoever, in law or equity, whether known or unknown, which I (or my heirs, assigns, agents and/or
representatives) ever had, now has, or in the future may have against the Releasees, including, but not
limited to, claims arising out of or related to the uses described herein, my participation and/or my
decision to perform this agreement and the production, promotion, distribution or exploitation of the
project. Moreover, this release shall be binding on all of my successors-in-interest and heirs. I further
agree that I shall be liable for any and all attorneys’ fees and costs incurred by Company in connection
with any claim or lawsuit brought in violation of this release.
Finally, I represent and warrant that I have the full right and authority to enter into this release; that all
information I am providing to Company on this release is valid, true and accurate; that any statements
made by me during my participation in any filming or project will be true; and, that the use by the
Company of my participation in the project, or of any of the rights granted hereunder, will not violate any
applicable law or any right of any third party. I understand that the Company is relying on my promises
and representations made hereunder in proceeding with the production and exploitation of the project.
Moreover, I understand and agree that nothing contained herein shall require Company or any third party
to use my participation in any project or filming (in whole or in part) or to develop, produce, exhibit,
distribute or otherwise exploit my participation and/or the finished project or, if commenced, to continue
the development, production, exhibition, distribution or exploitation of a project.
In no event shall I be allowed to terminate or rescind this release, and I shall not be entitled to equitable or
injunctive relief, all of which I knowingly waive. In no event shall I be permitted or have the right to
prevent or inhibit the development, production, exhibition, distribution, broadcast or other use or
exploitation of any project using the results and proceeds of my participation hereunder.
Company may transfer and assign this agreement or all or any of its rights or privileges hereunder, to any
entity or individual without restriction, which transfer or assignment shall relieve Company of all of its
obligations hereunder.
This release constitutes the entire understanding between the Parties and shall be construed and enforced
in accordance with, and governed by, the laws of the State of California, without regard to the conflicts of
law principles thereof. If any provision of this release is adjudged to be void or unenforceable, same shall
not affect the validity of this release or of any other provision hereof. The parties hereto agree to submit
to jurisdiction in the State of California. I understand and agree that for a non-guild production there will
be no residual or any other type of payment due in connection with my participation.
I have carefully read and fully understand everything contained in this document and have executed this
release voluntarily and without duress. I intend this document to be a complete and unconditional release
of all liability to the greatest extent allowed by law and agree that if any of the foregoing terms and
provisions should be determined to be invalid, the all of the other such terms and provisions shall
continue in full force and effect.
Signature:
Date:
Consent of Parent or Guardian [To be signed if the person signing the attached Release is
under the age of 18]
I acknowledge that I have read the foregoing Release and am familiar with each and all of the
terms, covenants and conditions contained therein, I am satisfied that said Release is fair and
equitable, and I hereby give my express consent to the execution thereof and will not revoke my
consent thereto at any time hereafter.
Parent or Guardian
Parent or Guardian
IDENTIFYING INFORMATION
NAME: _____________________________________________________________________________
DATE OF BIRTH: _____________________________________________________________________
ADDRESS: __________________________________________________________________________
CITY, STATE, ZIP: ______________________________________ TELEPHONE: ________________
[THIS INFORMATION IS BEING OBTAINED AND WILL BE MAINTAINED SOLELY FOR
LEGALLY-MANDATED RECORD-KEEPING PURPOSES.]